Middle Meningeal Artery Arising From the Basilar Artery: A Case Report and Review of a Rare Anatomic Variant.

background and importanceThe middle meningeal artery (MMA) typically arises from the internal maxillary artery and enters the cranium through the foramen spinosum. Rare embryological deviations may result in anomalous origins, including from the basilar artery, a variant with only a handful of angiographically confirmed cases reported. Most prior descriptions have been incidental and unassociated with significant pathology. CLINICAL PRESENTATION: A 56-year-old man presented with progressive right leg weakness and falls. Imaging revealed a left falcine meningioma, a right frontal meningioma, and a right parasagittal arteriovenous malformation (AVM). Digital subtraction angiography demonstrated an anomalous MMA arising from the mid-basilar trunk with an initial posterior deflection, caliber increase near the trigeminal ganglion, and subsequent intracranial course along a standard MMA distribution. The foramen spinosum on the anomalous side was intact. Surgical resection of the AVM and meningiomas was performed, with pathology confirming World Health Organization grade 2 (falcine) and grade 1 (frontal) meningiomas.

conclusionThis report describes the first documented case of a basilar-origin MMA supplying both a meningioma and an AVM. The case reinforces the embryological plausibility of basilar-trigeminal connections in MMA development and contributes to the anatomic and developmental understanding of this rare vascular configuration.